The death of Irish singer Dolores O’Riordain (from the Cranberries), is yet another celebrity demise that leaves us with more questions than answers. I’ve written about Dolores before (see here); in that post from 2014, I asked was Dolores on psychiatric drugs? As it turns out, according to the inquest into her death, she certainly was. She had four anti-depressants in her system at the time of her death (by drowning in a bath tub), and a high level of alcohol. Her death was recorded as accidental and alcohol was considered the culprit. She was also under the care of two psychiatrists; both quite well renowned.

If, as the article suggests, Dolores was receiving the best psychiatric mental health care available, then why did she die? Surely, if you could afford the best health care, your life should be extended not diminished? that’s usually the way it works right?

Not so, with psychiatric treatment.

Pulitzer prize nominated journalist- Robert Whitaker’s ‘anatomy of an epidemic‘ explains in detail why those who receive psychiatric care (mostly in the form of drug treatments) have shortened life spans and increased disability and disablement.

When someone gets diagnosed with a ‘mental illness’ – In Dolores’s case- Bi-Polar, it usually send them down a trajectory of psychiatric medication regimes, which can last for years, even decades. The multiple side effects from psychiatric drugs can end up being more of a problem than the original diagnosis. Often times the side effects can mimic psychiatric illnesses, leaving the person in a much worse state than if they weren’t on the drugs. It’s very hard to come off psychiatric drugs too, even if you want to, and due to their toxicity, many people are poor metabolizers of them anyhow, which means that the drugs build up in the liver, causing many physical and mental side effects to exacerbate over time.

It’s interesting to note also, that 4 anti-depressants were found in Dolores’s system at the time of her death. Why on earth would her psychiatrists prescribe her 4 different anti-depressants? This is a recipe for disaster. It’s this kind of poly-pharmacy that often kills, maims or disables psychiatric drug users because of the various interactions between the medications. I took Seroxat for a few years in my twenties, and it was a horrific experience, it changed my personality, made me unruly, aggressive, act out of character etc (these are all common well known side effects of Seroxat and other SSRI anti-depressants) so I can only imagine what it feels like to be prescribed multiple psychiatric drugs.

It seems Dolores’s story follows the same path as many of those who are prescribed psychiatric drugs over a long period of time. Usually the psychiatric diagnoses comes from a trauma. In Dolores’s case, she was sexually abused in childhood, and she became anorexic, it’s unclear when she was diagnosed with bi-polar, but it seems it was in young adult-hood or thereabouts. It’s safe to assume that she had been medicated for years because of this diagnosis. Once entered into this system of drugging it’s very difficult to get out of it, a lot of the time those who are prescribed psychiatric drugs over long periods of time, end up in a bad way.

This begs the question, who is responsible for her untimely death? Who is responsible for the prescriptions of multiple, mind-bending, personality changing, multiple-side effect psychiatric anti-depressant drugs that she was prescribed?

“…Dr Andrews conducted the toxicology tests and found Ms O’Riordan had a blood alcohol concentration of 330mg and urine alcohol concentration of 397mg.

Traces of four medications used to treat depressive disorders were found in her system but all bar one was within the low therapeutic range.

That fourth drug was found in only a slightly elevated range….”

What were the four medications used to treat depressive disorders that she was prescibed? and why were her psychiatrists not monitoring her and her prescriptions? why was she left alone in such a state with access to multiple psychiatric medications? were the psychiatrists tracking her reactions to the meds she was prescribed over the years?

One of Dolores’s psychiatrists was US psychiatrist Dr Robert Hirschfeld. When you google Hirschfeld, it’s interesting that the third link that comes up is from a blog from an ex-patient of his who seems not too happy with Hirschfeld’s apparent long links to psychiatric drug manufacturers.

“….Here’s a nice little tidbit. The questionnaire was “adapted with permission from Robert M.A. Hirschfeld, M.D.” So as an uninformed patient reading this (which I was at the time), I’m thinking, “Oh, this must be legit since they got permission from a doctor to use this checklist.”

There’s more than meets the eye here.

“….On the surface, Dr. Hirschfeld seems like an awesome doctor – and he very well may be. Dr Hirschfeld’s bio from the University of Texas Medical Branch at Galveston (UTMB) extols the “Professor and Chair” of its psychiatry deparment. He has history of working with various national organizations such as the National Depressive and Manic-Depressive Association, National Institute of Mental Health (NIMH), and National Alliance for Research on Schizophrenia and Depression (NARSAD). He’s written all kinds of articles and blah blah blah. He’s considered a leader in his research of bipolar disorder.

In fact, because Dr. Hirschfeld is so great, he’s a member of pharmaceutical boards and has acted as a consultant for pharmaceutical companies, according to ISI Highly Cited.com. Some of our favorite guys appear here: Pfizer, Wyeth, Abbott Labs., Bristol-Myers Squibb, Eli Lilly, Forest Labs, Janssen, and – lookee here! – GSK…..”

Most people don’t realize that bio-psychiatrists, like the ones who treated Dolores, are not concerned with helping their patients deal with trauma of personal problems. They are fixated on the brain of the ‘mentally ill’ person and not their emotions, or feelings. They treat the brain, not the person. I didn’t realize this myself, until I came off psychiatric drugs some years ago, and researched psychiatry and the drugs industry. I was absolutely shocked and appalled when I realized that psychiatrists were beholden to the drugs industry and saw no problem with selling themselves to the industry to make money. I was shocked to see that drug companies have been hiding side effects for years with many of their drugs, and that many tens of thousands of people’s lives were being destroyed due to the over-medicalization of human distress.

Ultimately, alcohol was deemed responsible for her untimely death, however it would seem to me that psychiatric drugs were a massive factor also. Anti-depressants don’t mix well with alcohol, I know this from personal experience, they also can make people crave alcohol sometimes, (to take the edge off). Of course- psychiatrists and the drug’s industry play down these side effects- they play down all side effects, because it’s in their interest to keep you, and everyone else, on these drugs. It’s not in your interest, it’s in theirs.

It seems to me that Dolores was just another victim of a psychiatric system that is completely corrupted by the pharmaceutical industry, and sees patients as mere fodder. It’s very easy to entrap vulnerable people in this system of continual over-diagnoses, mis-diagnosis and drugging, and it seems that Dolores fell foul of the all too usual trajectory of :

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The problem is he doesn’t seem to realize (or seem to care) that this is a problem and if he does realize (and still doesn’t care), then that is an even more disturbing problem…

Simon Wessely is the former president of the Royal College of Psychiatry UK, and I think it’s safe to say that he is not well liked by the public generally, in particular those harmed by psychiatric medications (and those who dispute his M.E. claims). Simon has been on my radar for a few years now, ever since I heard him declare on the radio (in a debate with James Davies) that he ‘has never worked for pharma‘; a quick google search revealed that he had in fact been sponsored (done talks etc) for pharma over the years (how many we don’t know, and how much money he earned we don’t know either).

When questioned subsequently on this (by the writer -and ex-Seroxat addict– Will Self – and Scottish psychiatrist Peter Gordon) Simon didn’t seem to think that his talks for Pharma were worthy of note- or even- debate. He also seemed to think that they didn’t really constitute ‘working‘ for Pharma.

Let me tell you this Simon, if you got paid by any pharmaceutical company for talking for them, or at a conference they sponsored, or a drug they sponsored/wanted you to promote etc, then you have worked for Pharma. Let’s not kid ourselves. Even if you think that they cannot influence you, the fact that you worked for them has already tainted you, and as the (former) head of psychiatry UK you should understand this. The fact that you don’t care is disturbing.

So did Simon Wessley work for Pharma? it seems he did. However whether Simon did a few talks for Pharma or not is merely a red herring because it’s Simon’s Royal College of Psychiatry UK (the body and institute itself) and the members of the profession -broadly- who have been corrupted by pharma for decades. Simon might have done a few talks for pharma, and he really might also believe he is not corrupted by that- however internationally- it is psychiatry as a whole that has been utterly corrupted by pharma (particularly in the US).

One psychiatrist doing a few talks for some pharmaceutical companies seems relatively harmless enough (doesn’t it Simon?), however when most psychiatrists all over the world are doing a few, some a lot, and some too many- that adds up to a whole lot of influence from Pharma doesn’t it? One little tainted apple on its own in a barrel might not rot, but put a load of rotten apples in and mix it with some relatively healthy ones and what will you get?

A seriously rotten barrel of apples.

When Pharma funds a lot of psychiatric research, provides drugs to peddle, and has many key opinion leaders in its pocket, then that – to me- is a dangerously unethical situation.

A situation which has created, drug scandal after drug scandal: Zyprexa, Risperdal, Seroxat, the Benzo crisis…. need I say more?

However, even this is a red herring, because Big Pharma’s influence on psychiatry is just one tentacle of influence that pharma has on society, and how it operates. Pharma also sponsors charities, funds medical research in colleges (medical and academic). Many rich and wealthy individuals (Lords, MPs as well too), corporations, pension funds etc have shares in pharmaceutical companies, and pharma provides jobs- loads of them. Big Pharma has the backing of governments world-wide. It has a stranglehold on medical research and health care. It’s a corrupt apple cart that nobody wants to rock… and it’s too big to be prosecuted.

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Following on from the BBC’s recent Panorama documentary on SSRI’s causing violence in some people, a series of articles defending the use of SSRI’s appeared in the media. One of the commentators (who also appears frequently on twitter defending the use of SSRI’s) is Dr Carmine Pariante.

Pariante is a psychiatrist, from Kings College London, and judging by his tweets he seems to believe firmly in the bio-medical/brain disorder approach to depression and ‘mental illness’. He also seems to have no problem accepting funding linked to various pharmaceutical companies.

“...Dr Carmine Pariante has received Funds for a member of staff and funds for research. Professor Pariante’s research on depression and inflammation is supported by: the grants ‘Persistent Fatigue Induced by Interferon alpha: A New Immunological Model for Chronic Fatigue Syndrome’ (MR/J002739/1) and ‘Immuno – psychiatry: a consortium to test the opportunity for im munotherapeutics in psychiatry’ (MR/L014815/1; together with GSK), from the Medical Research Council (UK); the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre in Mental Health at South London and Maudsley NHS Foundati on Trust and King’s College London; by Johnson & Johnson as part of a programme of research on depression and inflammation; and by a Wellcome Trust -led consortium that also include Johnson & Johnson, GSK and Lundbeck….”

Psychiatrists linked to drug companies (or just taking money from drug companies) are nothing new; it’s the norm. This kind of intrinsic conflict of interest is widely accepted in psychiatry. Psychiatry is awash with pharmaceutical money and influence, and has been for a very long time. Conflicts of interest are important, but in relation to this post, they don’t interest me that much.

What interests me most about Pariante is his appearance in an article in the Standard. The article is relatively balanced, and includes Pariante’s views on SSRI’s and some counter view points from Dr David Healy and Robert Whitaker. It also includes a comment from a woman called Martha, who used Seroxat-

Martha said:

…‘As a teenager, Seroxat gave me auditory hallucinations, night sweats and made me suicidal,’ she says. ‘Coming off it was like coming off heroin…” (Evening Standard Article 2017)

I find it interesting that it is stories like Martha’s (above) that get completely ignored by mainstream psychiatrists like Carmine Pariante. Pariante would likely dismiss Martha’s experience as ‘anecdotal’. He would probably attempt to link her Seroxat side effects to her ‘mental illness’ as opposed to highlighting any real serious problems with SSRI’s themselves. Pariante has faced a backlash of commentary, about his pro-SSRI views on Twitter, yet in most instances he fails to even respond to views that don’t concur with his own. He seems unwavering to any opinion that does not tally with the consensus of the royal college of psychiatry, and incidentally- the drug companies.

Why is Pariante so unwilling to engage with people who have had serious adverse effects of SSRI’s? Why is he so fixed in his views, why is he also unwilling (and seemingly unable) to listen to our experiences of the drugs that he promotes? Why does he ignore different opinions?

Could this have anything to do with his declared interests with the drug companies who manufacture (and profit off) psychiatric drugs, or is it merely because his psychiatric reductionist world-view has become utterly blinkered from his total immersion in the ‘biological brain disease paradigm’ of depression and mental illness that maybe he can no longer see the wood for the trees?

Maybe he needs to listen to his patients more?

Pariante states, in the Standard article, that antidepressants stimulate the birth of new brain cells and that they ‘regulate’ stress hormones, he also says that the chemical imbalance theory is too simplistic….

“…Experts argue that the ‘chemical imbalance’ theory is simplistic. Professor Carmine Pariante of King’s College, London, tells me: ‘The action of antidepressants is more complex than that and involves stimulating the birth of new brain cells and regulating stress hormones.’ However, it’s a shorthand that makes sense to many.”..

Psychiatry and drug companies sold people millions of SSRI’s in the 90’s and 2000’s on the basis that SSRI’s (like Seroxat) fixed a ‘chemical imbalance’ in people’s brains, and it was this imbalance (so they claimed) that was causing the person’s depression. Now, it seems psychiatry is trying to distance itself from the theory- is this perhaps because the theory itself was little more than a pharmaceutical marketing ploy? a fraud? a fairy-tale sold to vulnerable people in order to get them to take mind-bending pills?

Who is going to tell all those millions of people who took SSRI’s, that psychiatry has now abandoned the chemical imbalance theory? Who will tell them that they were duped? Will Pariante do it?

Whilst dispelling one myth (the chemical imbalance theory) on the one hand, Pariante seems to have no problem planting outrageous new ones (such as SSRI’s regulating stress hormones and making new brain cells) into the discourse about SSRI’s, in the media. You’d have to wonder, with folks like Pariante (considered ‘experts’) as part of the ‘authority’ on mental health, are patients being harmed or helped by these kinds of glib pseudo-scientific statements?

Personally, I would like to see the evidence that SSRI’s regulate stress hormones, I’d also like to see hard evidence that SSRI’s creating brain cells is a good thing (where in the brain do these ‘new cells’ appear – for example).

It wasn’t long ago that psychiatry was telling us that homosexuality was a mental illness.

Psychiatry changes its theories like the weather, it depends on which way the ‘consensus’ is blowing. It also depends on who is feeding the ‘consensus builders’.

The consensus is now being altered by the internet, and patients voices (on twitter etc).

No amount of ignorance from people like Carmine Pariante can quell the tide of change that is now happening online.

The drugs don’t work – psychiatric guru Ivor Brown says he would never give antidepressents to anyone

Our reporter talks to psychiatric guru Ivor Browne, who says he would never give antidepressants to anyone as they are ‘ineffective’. Others in his profession say the ­advice is ­misguided and even ‘dangerous’. As a new film opens detailing his methods, we explore the answers

For decades, Ivor Browne has been one of the best-known psychiatrists in the country.

Lauded by his admirers like a mystical guru, he has been credited with breaking down the walls of our mental hospitals, and freeing many patients from incarceration.

As a sprightly octogenarian who meditates twice a day and lives in a house named Gandalf – in honour of a character in JRR Tolkien’s The Lord of the Rings – he is no ordinary doctor.

One visitor to his home in South Dublin said the white-bearded figure looked like he had walked straight out of the pages of the Bible.

22Ivor Browne with playwright Tom Murphy during the film, The Wonder Eye: Meetings with Ivor

The writer Colm Tóibín, who has attended his therapy sessions, once said of him: “There’s an aura off him that is almost holy.”

The psychiatrist prompted Tóibín to unleash “unexperienced” pain over his father’s death when he was a boy of 12. Tóibín once wrote of how he once lay on a mattress and screamed with grief, having suppressed it for years.

As a psychiatrist, Browne is said to have “dried out” Ronnie Drew of the Dubliners, and there is no shortage of well-known figures who are prepared to endorse him.

Few doubt that he helped to shake up the world of Irish psychiatry over the decades, and shed light on a hidden world of mental anguish. But his views opposing the use of antidepressants are also highly controversial, and are heavily contested by many other psychiatrists working in Ireland today, including those who advocate talking therapies.

The psychiatrist is again in the spotlight as the subject of a documentary, now showing at Dublin’s Irish Film Institute. It not only tells the story of Browne’s life but also lifts the lid on our attitude to mental health and depression. Browne tells how when he started as a medical student, doctors were giving residents of mental hospitals lobotomies.

He recalls how he helped in operations, where holes were drilled in patients’ heads. A knife was inserted to sever the frontal lobes of the brain.

Browne sought to close the often inhumane institutions that house those with mental illness and wanted to integrate the patients into the community.

He acknowledged that this was only a partial success, and believes that many people out in the community are now institutionalised by heavy drugs.

The semi-retired former professor of psychiatry at UCD this week reaffirmed his view that there is a vast overuse of antidepressants in Ireland.

The debate over antidepressants is of concern to tens of thousands of people. The mental health support organisation Aware estimates 450,000 people are affected by depression in Ireland, the equivalent of one in 10, at any one time.

It is hard to quantify the number of prescriptions for antidepressant pills in Ireland every year, but Browne says if he was writing prescriptions nowadays he wouldn’t dream of giving an antidepressant drug to any of his patients. He claims they are “highly habit-forming and difficult to get off”.

“I think they are ineffective. They can give temporary relief but they don’t achieve any far-reaching results,” he tells Review.

It is a long-held view that inevitably makes Browne the target of criticism and out of kilter with the psychiatric establishment, particularly in cases where patients may be suicidal.

Browne, himself the former chief psychiatrist at the Eastern Health Board, emphasises that he is not totally against the use of drugs when treating patients. He says he would prescribe antipsychotic medication in cases of acute psychosis.

That is where a patient loses grip on reality, and may suffer severe hallucinations or delusions. As Browne puts it: “It’s what in ordinary parlance we would call ‘mad’. Otherwise I would not prescribe medication because I think it’s better to work with people’s difficulties, to help them discover the source of their problems,” he says.

“In my experience, medication makes it more difficult to deal with the underlying reasons for depression.”

So if the drugs don’t work, in his view, what would he recommend as the best treatment for depression?

“I would say, in broad terms, effective psychotherapy. If you can work on the person’s life story, and more specifically deal with any traumas people have suffered from the womb through birth, or in later development, you will make more progress.”

Browne says the deepest trauma of all is to be rejected or not wanted by a mother or father, or both.

The psychiatrist has often referred to his own complex relationship with his father, and a form of rejection from the time of his birth. Brought up in Sandycove at the southern tip of Dublin Bay, he regularly heard his father suggesting within his earshot: “I’m afraid Ivor was a mistake. I don’t know if I’ll ever be able to educate him.”

He has told how that his parents, wishing to have only two children, used an unorthodox form of birth control in which his mother kept the bedroom door locked. But Ivor, the third child, was conceived when his father crawled in through the window.

“I was seen as something of a problem and not the full shilling.”

His critics have suggested that depression is not always caused by trauma that can be uncovered by delving into the past. They point to those who suffer the condition without abusive incidents, hidden grief or neglect.

“I agree that depression is not always down to trauma,” says Browne. “Bipolar disorder (previously known as manic depression), for instance, was recognised right back through the history of psychiatry as involving a genetic component but also involved the person’s life story.”

He says some people have a natural tendency to such disorders but before the use of drugs became prevalent the incidence of this was rare.

“I would say that too much emphasis is placed on giving medication before exploring the person’s life story and any traumatic events as part of this.”

While those who have been treated by Browne are full of praise, is an effective talking cure really available for ordinary punters across the country suffering severe distress? Not everyone has access to a therapist of his calibre.

Browne is concerned that virtually anyone can set themselves as a psychotherapist, but believes the field is becoming more regulated now, especially at an EU level. He says treatments such as regression therapy, where patients go back through the subconscious memory to try to confront and tackle forgotten childhood incidents or traumas, require specialist skill.

“The ‘talking cures’ are not effective where the psychotherapist has not had proper training.”

Browne has often been prepared to go out on a limb during his career, and has attracted controversy as a result. In the 1990s, after it emerged that his patient Phyllis Hamilton had had a child with the high-profile priest Father Michael Cleary, Browne spoke out publicly with her consent to confirm her story. He was censured by the Irish Medical Council for breach of confidentiality, but the council rejected the charge that he had failed to act in the best interests of his patient.

It was a sign of a changing country that the council attracted as much criticism for its judgment as Browne did himself.

Browne now attributes growing dissatisfaction and depression to the changing nature of our ­society, and has said it is hardly surprising that people are unhappy when they spend eight hours at a computer screen and two hours driving in a day.

He likes to quote the Indian philosopher Jiddu Krishnamurti: “It’s no measure of health to be well adjusted in a profoundly sick society.”

The Wonder Eye: Meetings with Ivor opened at the Irish Film Institute, Dublin last night

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Psychiatrist Peter Kramer’s new book ‘Ordinarily Well: The Case for Antidepressants (2016)’ is reviewed by Dr David Healy on his blog (see below).

Whilst it does not surprise me that a psychiatrist like Kramer would publish a pro-anti-depressant book, it does disturb me how he got it published without mentioning the side effects, and the many controversies, surrounding the drugs- over the years.

Surely this is promoting ‘misinformed consent’?

Psychiatrists like Kramer put patients lives at risk.

We are lucky to have psychiatrists like Healy, to counter the balance.

Venomagnosia

Editorial Note: I was asked to review Peter Kramer’s Ordinarily Well: The Case for Antidepressants for ISIS. The in print review is HERE. There is a sister post on RxISK – with a better cartoon and where the word Venomagnosia s explained – Come Back When you Have a Medical Degree.

This book was very difficult to review. In Ordinarily Well: The Case for Antidepressants, Dr. Peter Kramer makes two arguments that I agree with. One is that clinical observation—the interaction by which a medical professional learns about a patient—counts for something. The other is that clinical trials, or evidence-based medicine more generally, are not a replacement for clinical wisdom. He values antidepressants, in particular the selective serotonin reuptake inhibitor (SSRI) class of drugs, and so do I.

Applying support for clinical observation and skepticism about controlled trials to the question of whether antidepressants work, Kramer concludes that these treatments work very well. En route, he focuses on the claims of psychologist Irving Kirsch, among others, that based on clinical trial data, the benefits of antidepressants are all in the mind—a placebo effect. Kramer makes a straw man of Kirsch, but I agree with Kramer that antidepressants do things that are not all in the mind. I too reject Kirsch’s arguments that most of what antidepressants do stems from a placebo effect.

So where did my difficulties in reviewing the book come from? The trouble for me is that Kramer’s clinical vision seems strangely rose-tinted. He is an advocate of using antidepressants to treat depression, but he doesn’t seem to see any of the problems antidepressants cause. The fact that over half of the patients put on them don’t take them beyond a month should be telling. For those who do stay on treatment, he claims, no one has difficulties going off antidepressants with a gradual reduction in dosage. I, however, have patients suffering badly months or even a year later. In the case of any enduring problems, Kramer puts these down to the effects of the illness being treated rather than the medication.

There is no discussion in this book of significant problems that the use of antidepressants can cause. These include SSRI-induced alcoholism, SSRI-induced birth defects, including autism spectrum disorder, or permanent post-SSRI sexual dysfunction. In a 336-page book, the topic of SSRI-induced suicidality gets dealt with in one page. I think many surviving relatives would be astonished to hear that once the psychiatrist Martin Teicher had identified the problem of treatment-induced suicide, it became manageable. Kramer claims that “no case [he has had], not one, has looked like those Teicher has described, drug driven.”

Kramer asks us to believe in clinical observations—his observations. Not yours or mine or anyone’s that might cause the antidepressant bandwagon to wobble. He cites me at multiple points, so he is well aware of my work. But he doesn’t engage with the evidence that I and others have put forth, based on both clinical observations and other material, that SSRIs can unquestionably cause suicides and homicides, and do so to a greater extent than they prevent any of these events.

On the issue of children, suicide, and the black box warnings that antidepressants now carry, Kramer notes that “some of the data have trended the other way, although authoritative studies correlate increased prescribing with reduced adolescent suicide.” This fails to acknowledge that the drugs haven’t been shown to work in this age group. There is no mention that suicidal acts show a statistically significant increase in clinical trials in this age group. Kramer also does not indicate that among all ages, when all trials of antidepressants are analyzed together, they show increased rates of death (mainly from suicide) compared to non-treatment. He seems to have no feel for how compromised the “authorities” are that he uses to downplay the risks.

There are good grounds to be skeptical of the evidence-based medicine that Kramer uses to make his case. Quite aside from the fact that almost all the research literature produced by clinical trials is ghost written by pharmaceutical companies, and the data from them entirely inaccessible, controlled trials aren’t designed to show that drugs work. They work best when they debunk claims for efficacy, rather than the reverse. What’s more, the structure of clinical trials and their statistical analyses are the best method to hide a drug’s adverse effects. Ordinarily Well does not address these significant problems.

If a drug really works, then clinical observation should pick it up. We can tell antihypertensives lower blood pressure, hypoglycemics lower blood sugar, and antipsychotics tranquilize within the hour—all without trials. We can see right in front of us that antipsychotics badly agitate many people within the hour and that SSRIs can do so too. But we cannot see anyone get better on an antidepressant in a way that lets us as convincingly ascribe the effect to the drug. There is much to be said for clinical observation, but also a lot to wonder about when clinical trials suggest that drugs work but we can’t actually see it. For anyone keen to defend clinical observation, Kramer’s book poses real problems and would leave many figuring we need controlled trials instead.

I live and work in the United Kingdom and am acutely aware of some differences between America and Europe that also made it difficult to review this book. There is much more “bio-babble” in America than in Europe, from talk of lowered serotonin to chemical imbalances to neuroplasticity and early treatment preventing brain damage—all of which Kramer reproduces. I felt a John McEnroe “you cannot be serious” coming on at many points. The tone in which some of these points are made suggests that everyone reading them will find what is being said self-evident, when in fact it’s gobbledegook.

All medicines are poisons, and the clinical art is bringing good out of the use of a poison. It strikes me as un-American to even suggest that a drug might be a poison, and Kramer’s book gives no hint of this; the book is, in this sense, deeply non-clinical. He is giving an account of a mythical treatment, as far removed from real medicine as an inflatable sexual partner is from the real thing. It seems to me that he would not see or hear many of the patients I see, or at least would not credit their view of what is happening to them on treatment. This book will misinform anyone likely to take an antidepressant.

It will also cause problems for physicians. This book does not balance the risks and benefits that are intrinsic to medical wisdom. If antidepressants are as effective as Kramer claims, and are as free of problems as he suggests, there is no reason why nurses and pharmacists couldn’t prescribe them. Given that they are much less expensive prescribers, the surprise is that health insurers haven’t moved in this direction.

There is a way to bridge the gulf between Kramer and myself, which involves clinical observation. Most of the beneficial effects Kramer describes can be reframed in terms of an emotional blunting, or the numbing of all emotions, not simply the bad ones. Just like people on an SSRI will nearly universally report genital numbing within 30 minutes of taking their first SSRI—if they’re asked—people will also report some degree of emotional numbing—if asked. They don’t necessarily feel better; they simply feel less.

Unlike the somewhat mystical brain re-engineering Kramer invokes, this emotional blunting can be verified by clinical questioning. If clinical trials were designed to assess whether patients are numbed by these drugs, there would be little need for the fancy statistics that pharmaceutical companies use to claim the targeted benefits of their drugs, since emotional blunting would be evident through clinical questioning. And Irving Kirsch’s arguments about placebo would be irrelevant.

If SSRIs numb emotional experience, this would explain why they help some and not others, and explain the results we see in clinical trials, which are similar to the results that might be expected from a trial of alcohol versus placebo in the milder nervous states in which antidepressant trials have been run. This, then, would present us with a question: what do we think about emotional blunting as a therapeutic tool? Emotional blunting is not a romantic option. It’s a much more ordinary one. If that is the process by which antidepressants work, it does patients an enormous disservice to avoid discussing it entirely, which this book does.

The terrorist who killed 84 people including at least 10 children in Nice had suffered from ‘psychological problems’, it has been revealed.

Mohamed Lahouaiej Bouhlel, 31, a French Tunisian and married father of three, had suffered a nervous breakdown and received medical treatment for mental health issues for ‘several years’ before leaving Tunisia for France in 2005, his family said today.

Bouhlel was shot dead by police after he ploughed a lorry into crowds of people who had gathered on the city’s Promenade des Anglais to watch Bastille Day fireworks. The attack left 202 people injured, including 50 who are ‘between life and death’, according to President Francois Hollande.

Five people connected to Bouhlel have been questioned as part of the police investigation, including his estranged wife Hajer.

Previous reports suggested Bouhlel was depressed about the break up of his marriage before he mounted the pavements at high speed and careered into the revelers on Thursday night.

The killer’s father, Monthir Bouhlel, claimed his son suffered from psychological problems and was sometimes unstable. “He had some difficult times, I took him to a psychiatrist, he took his treatments and he said he had a serious mental illness.

“For four years, from 2002 to 2004 he had problems, he had a nervous breakdown. He would get very angry, and would break things for no reason, he was put on medication. But the one thing he did not get angry about was religion, he did not go to mosque, he drank.”

Some interesting news coming out about the Nice Van Attack Terrorist, Mohamed Lahouaiej Bouhlel. According to some news outlets he was receiving psychological and psychiatric treatment for ‘several years’ before he carried out the attack.

Psychiatric and psychological treatment, almost always, means the prescribing of psychiatric drugs. If Mohamed Lahouaiej Bouhlel was prescribed psychiatric drugs for several years, it would be interesting to find out what drugs they were, on what dose was he prescribed them, and for how long?

Psychiatric drugs (such as anti-depressants like Seroxat, and anti-psychotics) are notorious for causing psychotic, manic and homicidal/violent/aggression reactions. The BBC are currently investigating the violence aspect of anti-depressants for a forthcoming documentary, according to Katinka Blackford Newman (author of a new book about her personal experience of SSRI’s and the devastation she suffered because of them).

It will be interesting if we find out what psychiatric drugs the Nice terrorist was on, and if these drugs contributed to this terribly violent act.

My heart goes out to all those who died, and to the injured, and their families, from the Nice tragedy. I have been to Nice several times (growing up we used to camp near Nice) and I have an affinity with that part of the world.

The websites AntiDepAware and SSRI Stories have both been documenting medication induced violence etc for years…

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According to Christopher Harper Mercer’s (the Oregon shooter’s) mother:

“She said that ‘my son is a real big problem of mine’,” Alexis Jefferson, who worked with Harper at a care center in 2010, told the Times. “She said: ‘He has some psychological problems. Sometimes he takes his medication, sometimes he doesn’t.

Anytime I hear of a mass murder, a murder suicide, or a very violent suicide, I immediately think of psychiatric drugs. I do this because I know, from first had experience, that psychiatric drugs are extremely dangerous. They made me aggressive, hostile, and suicidal, as a young man, and they can push anyone over the edge. There are thousands of first hand patient reports of how these mind bending medications can literally destroy you psychologically. Homicide, violence and violent suicides are not hallmarks of depression, but they are common side effects of psychiatric medication. People, are still largely ignorant of these side effects though, and doctors and psychiatrists don’t warn or monitor people properly.

“… the gunman’s mother sometimes confided the difficulties she had in raising her son, including that she had placed Mr. Harper-Mercer in a psychiatric hospital when he did not take his medication.”

….”This confirms, at least, the Oregon shooter’s access to psychiatric drugs. Young people sometimes throw their drugs together and take them randomly as if they were recreational. Additionally, Mercer was also known to have graduated from a high school for youngsters with emotional and behavioral problems…” (Peter Breggin: Mad In America)

If the recent BMJ study into Paroxetine (Paxil/Seroxat/Aropax) and it’s links to an increase in suicide in under 18’s, and the recent study which linked all the SSRI’s to an increase in violence, doesn’t wake people up to the dangers of all psychiatric drugs, then I don’t know what will… psychiatric drugs can be particularly dangerous in withdrawal, or over the long term and it seems that the Oregon shooter was perhaps coming off his the drugs at the time of the shooting, however the details are unclear at this time.

We don’t know yet either, what drugs Christopher Harper Mercer was prescribed, or his psychiatric history etc… however we do know that there have been far too many murders, suicides, killing sprees and school shootings linked to these drugs.

An influential study which claimed that an antidepressant drug was safe for children and adolescents failed to report the true numbers of young people who thought of killing themselves while on it, re-analysis of the trial has found

Study 329, into the effects of GlaxoSmithKline’s drug paroxetine on under-18s, was published in 2001 and later found to be flawed. In 2003, the UK drug regulator instructed doctors not to prescribe paroxetine – sold as Seroxat in the UK and Paxil in the US – to adolescents.

But experts who have obtained the original data say the study is still referred to in the medical literature and needs to be retracted.

Young people taking antidepressants such as Prozac and Seroxat are significantly more likely to commit violent crimes when they are on the medication, but taking higher doses of the drugs appears to reduce that risk, scientists said.

In research published in the PLoS Medicine journal, the scientists said that while their finding of a link does not prove that such drugs cause people to be more violent, further studies should be conducted and extra warnings may be needed in future when they are prescribed to people aged 15 to 24.

“..In December 2003, O’Mahony’s husband died from suicide, following a bout of mild depression. After her husband was prescribed the SSRI, Seroxat, O’Mahony claims that his symptoms became progressively worse, culminating in his suicide 13 days later.

“I am not saying that Seroxat caused my husband’s suicide, but I do think that it had a significant role to play in the deterioration of his condition, which eventually ended in his death,” says O’Mahony.

“Which is why I am calling for access to full and impartial information about the potential risks and adverse effects of prescription medication…”

(Irish Times 2005)

“It was a letter from a member of the public, Nuria O’Mahony, which in part prompted last week’s report from an Oireachtas health subcommittee on adverse drug reactions (ADRs) in pharmaceuticals.

Convinced that her husband had taken his own life because of side effects from antidepressants, she wanted answers. “….

“The first thing I find reassuring is that everywhere I go, doctors are aware of this as an issue . . . people are aware of it and are questioning how to deal with it,” he says. “Secondly, the regulatory body has set out certain guidance and is continually reviewing that.”

Hillery ran as a candidate for Fianna Fail in an election and he is also the son of a former president of Ireland. I’m sure he was probably cushioned from most of the harsh affects of Ireland’s national economic depression and societal collapse (there’s good money in politics and psychiatry you know!).

“…Some call themselves anti-psychiatry, some are part of the critical psychiatry movement, or promote the theory of “post psychiatry”. Others just know there has to be a better way…”

(Jennifer Haugh Irish Examiner Sept 2015)

“…Less than a third of people with common mental health problems get any treatment at all – a situation the nation would not tolerate if they had cancer, according to the incoming president of the Royal College of Psychiatrists.”..

(2014)

“...Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, said: ‘That antidepressants are helpful in depression, together with psychological treatments, is established. How they do this is not.

‘Most researchers have long since moved on from the old serotonin model…”

(2015)

“…With the advent of the chemical imbalance theory, the companies were no longer just providing soothing tonics, they were now providing medications to treat diseases, as exemplified by an early SSRI advertisement stating: “When serotonin is in short supply, you may suffer from depression.” The wording here is all-important. The advertisement takes a correlation between serotonin shortage and psychological stress-and even this is highly questionable and unverifiable in any individual case-and makes a leap of faith to the conclusion that depression is caused by a serotonin imbalance, not that psychological stress impacts the serotonin system. And the marketing did not stop with depression; eventually we were told that whatever our problems might be, whether anxiety, excessive shyness, depression, or the inability to pay attention, the underlying cause was a faulty transmitter level which could be rectified with a pill…”

Up until recently (or at least the past 5 years or so) many psychiatrists, doctors, patient groups, and pharmaceutical companies continually promoted the mantra that mental illnesses (depression in particular) were caused by a mere chemical imbalances in people’s brains. The public (patients, doctors, carers, parents etc) all swallowed this mantra, hook line, and sinker- for decades. Many millions of people, world-wide for the past 30 years at least, have been medicated with anti-depressants solely based on this theory alone. I remember my doctor telling me in 1998, that I had a chemical imbalance and that I would need to take Seroxat (Paxil) for life in order to treat this ‘imbalance’ (luckily I got off it- wasn’t easy but I haven’t taken a pill for depression since so effectively my doctor was wrong).

This fraudulent theory has permeated mental health discourse, and many people were duped into taking medications which they did not need- and many have also been damaged from the meds too.

Who is responsible for this fraud?

GSK, the manufacturer of Seroxat (the drug which was pushed on me) said in their PIL in 2003- that :

“….by mid 2006 GSK was starting to get closer to admitting the truth in its PIL “It is not fully understood how Seroxat and other SSRIs work…”

This (fraudulent) theory was even promoted by so called ‘mental health support groups’ such as Aware ( an Irish group- who from my experiences with them seemed merely just a front for St Patrick’s biological psychiatry agenda) and others in the UK, and elsewhere.

In the 90’s and the 2000’s you couldn’t read anything about depression anywhere, without seeing some kind of reference to the biological basis (or chemical imbalance theory) of depression, and other psychiatric disorders. The ‘chemical imbalance’ bogus lie was told everywhere.

By the mid 2000’s the fact that there was no way to test for low serotonin levels, and that there was no medical test for any psychiatric disorders, began to weave its way into the discourse about mental health (particularly online and as online discourse began to take over). It was around this time (under criticism, and attack from ex-patients and critical psychiatrists and psychologists during the mid 2000’s) that psychiatry began to back track on their promotion of the chemical imbalance theory.

They began to try and appear like they never really promoted it at all, and they now want us to believe that:

“I don’t believe the chemical imbalance theory is still widely believed in Ireland,” he says. “It’s not something that I would have told patients, I would have told people about the theories… and that there is a lot of evidence to show they [medications] help people. But they are not going to help everyone and should be part of a treatment package that includes talking therapies and other forms of support.”

Hillery says the college does not have an “official position” on the chemical imbalance theory.

Psychiatry is now in denial mode (or even worse- ‘re-write the historical record mode’). The psychiatric profession is pretending now that it had no real part in this fraud at all, however at the same time, despite back tracking on the chemical imbalance fraud (which it has effectively instilled into psychiatric treatments, and the public mind, for the past few decades) psychiatrists are still trying to push medications as first line treatments for depression.

“Hillery of the College of (Irish) Psychiatrists says the college is pushing the “bio/psycho/social model” and the recovery concept, and teaches trainee psychiatrists to look beyond the medical model. “I would hope people are being told they can recover, and can eventually get off medications… some can get off them, but others will need to remain on them.

“One of biggest frustrations we have is a lack of access to other therapies for people who can’t pay…”

It’s interesting how Dr John Hillery of The College of Irish psychiatry (and most other schools such as the royal UK one) are now claiming that they are telling people that they can recover from mental illness, and that some, at least – can get off the medications. It is also interesting to see people like Hillery say that the theory of a chemical imbalance is not widely believed in Ireland anymore. This is an outstanding reversal of belief, it’s also not true, because the chemical imbalance explanation of depression is still very much widely believed in Ireland (and indeed it is globally too). It is because of psychiatry pushing this theory relentlessly (on behalf of drug companies) that we had such widespread prescribing off the back of it. The theory is a myth, but psychiatry haven’t even begun to tell the truth about the myth.

This is also a stark difference in approach by Irish psychiatry ( or at least it appears that way) compared to 1998 when I was prescribed Seroxat. Furthermore, although psychiatry is now shying away from its responsibility in promoting the chemical imbalance theory (which it endorsed and sold to us for decades), it’s also admitting that there is a severe lack of availability of talk therapy, therefore what use is their new claim that anti-depressants are useful in conjunction with talk therapy?

If there is a severe lack of talk therapy, then people aren’t getting adequate treatment or effective treatment at all are they? and what does depression treatment entail nowadays? It entails drugs without talk therapy, it’s still just drugs, it always has been just drugs in psychiatry, and it continues to be because psychiatry believes in the drugs as first line treatments, so when they say get ‘treatment’ for depression, invariably most people will still end up on chemicals like Seroxat because that’s all psychiatry has to offer (and it intends to keep it that way despite trying to make it appear that there are ‘options’ other than meds).

Biological psychiatrists don’t value (or really believe in) talk therapies as solutions to mental health problems therefore they don’t lobby their respective governments for it. They try and make the public believe that they value them but it’s clear that they don’t. They try to claim there is a lack of funding too, however, if you research psychiatry you will find it’s a very lucrative and wealthy profession, so the lack of funds for talk therapies really doesn’t wash with me. Their ideology is drug based, and it always has been (the pharmaceutical industry owns psychiatry nowadays). Their promotion of the chemical imbalance theory was a fraud which damaged an entire generation of people, they just can’t avoid that fact and they cannot shirk away from the major part they played in it by attempting to pretend it never really happened. How arrogant of psychiatry to think it can erase, delete, and re-write its own history! (not content with fiddling with patients’ personal histories, it now wants to fiddle its own).

Thankfully, which I have already mentioned- Dr Terry Lynch has documented the chemical imbalance fraud in his new book, Depression Delusion, so when the psychiatrists start coming out with more nonsense about not really promoting this fraud in the first place then at least we have a published book which documents it in its entirety.

So the next time a doctor tries to push a drug on you for a chemical imbalance, get Terry’s book, read it, then make your doctor read it, push it on him/her in the same manner that he/she would push a drug on you- and for anyone else interested in these things generally (psychiatry, the pharmaceutical industry, depression etc), it’s well worth checking out- here are some reviews:

Here are nine endorsements of the book by prominent figures in mental health internationally:

“Terry Lynch is a courageous voice of scientific and moral truth in a field too long obscured by psychiatric and drug company propaganda. In debunking the myth of ‘biochemical imbalances’, he provides an inestimable service to the health professions and to humanity by liberating them from a dogma that inhibits real psychological and spiritual growth.”

“Terry Lynch has given one of the most pervasive and harmful myths of modern times a thorough debunking. Exposing the truth that there is no scientific grounding to the idea that depression is caused by a chemical imbalance is essential if we are to develop a more constructive response to psychological distress and suffering.”

(Dr. Joanna Moncrieff, psychiatrist, Senior Lecturer at University College, London, England, in the Division of Psychiatry, honorary consultant psychiatrist,author of The Myth of the Chemical Cure).

“This will be a very helpful book. I spend a lot of time talking with patients and their families about the limitations of psychiatric knowledge. I try hard to be transparent about the pros and cons of psychotropic drugs. One of the great myths that many people have bought into is the ‘chemical imbalance’ theory of depression. Now I can happily point them to Terry’s book for a comprehensive account of how that myth was developed and how it is sustained. Thank you!”

“In this book the courageous Irish physician Terry Lynch has taken on the fiction of ‘chemical imbalances’. With no scientific evidence for this nonsense whatsoever, the psychiatric establishment, and the drug companies who own them, have been perpetrating an enormous fraud on the public. Doctor Lynch lays bare that this theory has no factual basis at all. I urge everyone concerned about the issue to read this important book.”

“Dr. Terry Lynch in his book Beyond Prozac showed that he wasn’t frightened to throw down the gauntlet and challenge the status quo within mainstream mental health care. In Depression Delusion, Dr. Lynch has surpassed this and thrown himself into the lion’s den with gusto! Many mental health professionals, medical doctors, drug companies, members of the public and the mass media continue to propagate the ‘chemical imbalance’ theory of depression. Through extensive and valid research Terry takes the reader on an epic journey revealing why this myth needs to be eradicated. When this delusion is destroyed we will all need to decide how we view and deal with depression in the future. Terry continues to address these very important questions in detail. If you still hold to the belief that the world is flat, then Depression Delusion will rock your very foundations!”

“It was the delusion that a chemical brain imbalance could cause the problems I experienced for over two decades that actually caused me and my family severe distress. It was meeting and hearing Terry Lynch that helped me to find out the truth. It is the myth of the chemical brain imbalance theory that continues to give deceptive, coercive psychiatry the power to force psychotropic drugs and electroshock on vulnerable people. Terry Lynch’s new book Depression Delusion will hopefully educate many, many others so that finally this myth will be exposed and eliminated. Everyone who wants to know the true facts will want to read this book.”

“I am a big fan of Terry’s first book Beyond Prozac, and Depression Delusion does not disappoint. A thorough, forensic examination of Western psychiatry’s (mis)treatment of depression, and how doctors and mental health professionals are all too often misinformed about the facts concerning antidepressant treatment. When Terry describes his work with people suffering from depression, it is clear that what is required instead is compassion, empathy and gaining a real understanding about someone’s story. Terry’s insights into the reasons why we become depressed should form an integral part of all mental health training.”

“It is widely accepted by professionals, the media, ordinary people and psychiatric service users themselves that mental distress is caused by a ‘chemical imbalance in the brain.’ There is no evidence that this is the case. In fact, there never has been any evidence for such a statement. Moreover, senior psychiatrists and drug companies have known they were making false claims for the 50 years or so that this myth has been circulating. How and why did this massive deception occur, and in whose interests does it operate? Terry Lynch’s remarkable detective work traces the horrifying story back to its roots in the drive for drug company profits and the complicity of a profession trying to establish its medical credentials. Meanwhile, millions of psychiatric service users have been told damaging falsehoods which have directly supported an equally unevidenced biomedical model of intervention. Psychiatrists are rapidly backpedalling—but Lynch is not about to let them off the hook. He has written a thorough and principled expose of the ‘chemical imbalance’ rhetoric and its devastating consequences. Read it for essential enlightenment about one of the most damaging myths of our time.”

“In challenging the very dangerous pseudo-scientific explanations of depression, Dr. Terry Lynch brings his medical background and his scientific integrity to bear on the issue. It was this powerful combination first seen in Beyond Prozac that attracted the interest and support of Dr. William Glasser, the creator of Reality Therapy and Choice Theory psychology, a long-time challenger of the chemical imbalance hypothesis. The Depression Delusion is essential reading for those who experience or deal with depression, one of the most painful of human conditions”.

We know from this internal memo and position piece that the initial SKB interpretation of the efficacy results from Study 329 mirrored those reported in our RIAT article:

14 OCT 1998

Please find attached to this memo a position piece, prepared by Julie Wilson of CMAT, summarising the results of the clinical studies in Adolescent Depression.

As you will know, the results of the studies were disappointing in that we did not reach statistical significance on the primary end points and thus the data do not support a label claim for the treatment of Adolescent Depression. The possibility of obtaining a safety statement from this data was considered but rejected. The best which could have been achieved was a statement that, although safety data, was reassuring, efficacy had not been demonstrated. Consultation of the Marketing Teams via Regulatory confirmed that this would be unacceptable commercially and the decision to take no regulatory action was recently endorsed by the TAT.

As you will see from the position piece the positive trends In efficacy which were seen in Study 329 are being published as a poster at ECNP this year and a full manuscript is in development. Published references will therefore be available for the study. There are no plans to publish data from Study 377.

This report has been prepared for internal use only. Data on File summaries will be prepared and issued once the final reports from the studies have been approved. This position piece will also be available on the Seroxat/Paxil resource database.

TARGET [from the Wilson position piece mentioned above]To effectively manage the dissemination of these data in order to minimize any potential negative commercial impact…

This was, indeed, a negative study, though the published article reached the opposite conclusion [2001]:

Paroxetine is generally well tolerated and effective for major depression in adolescents.

Three years ago, when I reviewed the exchange between Healthy Skepticism and the editor of the publishing Journal of the Academy of Child and Adolescent Psychiatry [see the lesson of Study 329: naked Emperors, fractious Queens…], I left out parts of the author’s response to the letter from Jureidini and Tonkin [2003]. This is where they attempt to explain “why” they felt justified in using the non-protocol outcomes:

This study was designed at a time when there were no randomized controlled trials showing antidepressant [tricyclic antidepressant or SSRI] superiority to placebo, so we had no prior data from which to astutely pick our outcome measures. The field has moved strongly away from using the Hamilton Rating Scale for Depression [HAM-D] in adolescent treatment studies and has gone virtually uniformly to using the Children’s Depression Rating Scale-Revised because the latter better and more reliably captures aspects of depression in youth. Surely a national regulatory body charged with approving or not approving a medication for a particular use might well simply say that if a study does not show efficacy on the primary endpoint[s[, it is a failed study and secondary outcome measures cannot then be used for approval. However, as scientists and clinicians we must adjudge whether or not the study overall found evidence of efficacy, and we do not have the convenience of falling back on such a simple rule. If we choose wrongly [in whichever direction], we don’t treat depressed children as well as the data would permit. Because we found a clear pattern of significant p values across multiple secondary analyses [recovery as assessed by HAM-D < 8, HAM-D depressed mood item, the Schedule for Affective Disorders and Schizophrenia for School-Age Children depression item, and Clinical Global Impression score at endpoint], we thought and still think this provides significant evidence of efficacy of paroxetine compared with placebo in adolescent depression. Without established reliable measures that distinguish medication responders from nonresponders at the time the study was designed, it is not surprising that the primary measures did not reach significance while other measures did. It still provides a strong “signal” for efficacy…

Creative! I expect that the comments about the CDRS-R [Children’s Depression Rating Scale-Revised] are in the vicinity of reasonable. One wonders why they didn’t say this in the first place in either the article or the Clinical Study Report. But if you take a look at several previous posts [paxil in adolescents: “five easy pieces”…, an addendum…, and follow-up…], you’ll see a definitive counter to this creative, latter day response [also apparent in this timeline]:

At the time the 329 authors wrote their response to Jon Jurieidini and Ann Tonkin in May 2003, SKB [GSK] had already completed two other Clinical Trials of Paxil in adolescents – one of them actually using the CDRS-R as a primary outcome variable. Those two studies were eventually published [after the patent for Paxil expired], but they were conducted much earlier and SKB [GSK] had the results [top figure]. When they used the CDRS, Placebo actually beat Paxil [bottom figure in yellow]. So at the time of that authors’ response letter, they justified what they’d said in Study 329 with an argument they’d already tested and already knew was a dead end [Study 701]:

Conclusions: No statistically significant differences were observed for paroxetine compared with placebo on the two prospectively defined primary efficacy variables. Paroxetine at 20–40 mg/day administered over a period of up to 12 weeks was generally well tolerated.

Journal of the American Academy of Child and Adolescent Psychiatry. 2006 45[6]:709-719.

…

Conclusions: Paroxetine was not shown to be more efficacious than placebo for treating pediatric major depressive disorder.

It may seem an odd way to end this particular run-on series of blog posts using a paragraph from a letter now over a decade old. But in study 329 vi: revisited…, I said, “the erroneous conclusion in Keller et al can hardly be chalked up to a mistake. It shows too many tell-tale signs of intention.” That’s an opinion, my strong opinion, and I wanted to back it up with an example that didn’t just come from our reanalysis. In the very first real challenge to the article back in their 2003 letter to the JAACAP, Jon Jureidini and Ann Tonkin of Healthy Skepticism clearly saw what it has taken fourteen years of dogged persistence to finally insert into the literature in the form of our RIAT article [see the lesson of Study 329: naked Emperors, fractious Queens…]:

The article by Keller et al. [2001] is one of only two to date to show a positive response to selective serotonin reuptake inhibitors [SSRIs] in child or adolescent depression. We believe that the Keller et al. study shows evidence of distorted and unbalanced reporting that seems to have evaded the scrutiny of your editorial process. The study authors designated two primary outcome measures: change from baseline in the Hamilton Rating Scale for Depression [HAM-D] and response [set as fall in HAM-D below 8 or by 50%]. On neither of these measures did paroxetine differ significantly from placebo. Table 2 of the Keller article demonstrates that all three groups had similar changes in HAM-D total score and that the clinical significance of any differences between them would be questionable. Nowhere is this acknowledged. Instead:

The definition of response is changed. As defined in the “Method” section, it has a nonsignificant p value of .11. In the “Results” section [without any explanation], the criterion for response is changed to reduction of HAM-D to below 8 [with a p value of .02]. By altering the criterion for the categorical measure of outcome, the authors are able to claim significance on a primary outcome measure.

In reporting efficacy results, only “response” is indicated as a primary outcome measure, and it could be misunderstood that response was the primary outcome measure. Only in the discussion is it revealed that “Paroxetine did not separate statistically from placebo for…HAM-D total score,” without any acknowledgment that total score was one of the two primary outcome measures. The next sentence is a claim to have demonstrated efficacy for paroxetine.

Thus a study that did not show significant improvement on either of two primary outcome measures is reported as demonstrating efficacy. Given that the research was paid for by Glaxo-Smith-Klein, the makers of paroxetine, it is tempting to explain the mode of reporting as an attempt to show the drug in the most favorable light. Given the frequency with which it is cited in other scientific papers, at conferences and educational functions, and in advertising, this article may have contributed to the increased prescribing of SSRI medication to children and adolescents. We believe it is a matter of importance to public health that you acknowledge the failings of this article, so that its findings can be more realistically appraised in decision-making about the use of SSRIs in children.

With a careful reading, they saw through to the essence of what was wrong without the benefit of any of the back story, the raw data, or the numerous analyses that have followed over the years about this study. It’s a great example for all of us to emulate. Being a doctor is hard work by any standard, and we feel good about putting in all the extra time it takes to stay current. I doubt there’s any profession that can claim the “life-long-learning” moniker any more than we can. You never really graduate from medical school and there’s a never ending series of tests [AKA patients] as long as you’re in the game. So we get used to scanning, reading non-critically, in part because of the volume. But every one of us needs to learn how to recognize the signs that a given article needs to be read like Jon and Ann read this one. The modern industry sponsored Clinical Trial literature in all of medicine is filled with articles that need a long second look. Without thinking, I coined a phrase answering a reporter’s questions about our paper, “it wasn’t sin – it was spin.” In the political arena, they call it plausible deniability. I don’t really believe it wasn’t sin [it may be the biggest sin of all because it’s the kind people get away with]. But the phrase still conveys a useful diagnostic take-home message to remind us what we’re on the lookout for…

” The message that we need to get across is that it’s deal-able with.. it’s scientific.. there’s a way of treating it…”

“… There is so many approaches to take… You’ll see that there are so many roads to take…

“.. the one I took was personal fitness... Serotonin levels..:’

(Bressie Prime Time RTE 2013, Psychiatrist Jim Lucey Was also on the panel)

First of all Bressie, I’d like to say, I think that your mental health activism is genuine, however I think in regards to your views on Depression being a ‘chemical imbalance’- I think you are seriously misguided. If you did some research, even for 5 minutes on the internet, you would see that this theory has been thoroughly debunked, in fact, it was never proven in the first place, and was merely a pharmaceutical marketing ploy (See Dr David Healy’s Recent Paper Here In The BMJ).

The ‘chemical imbalance theory’ has been a winner for psychiatry, and the pharmaceutical industry which it covets and protects. The losers, have been people like me (and tens of thousands of others); people who lost years in a medicated haze, not warned, and not informed- of side effects etc. We were told we had a chemical imbalance and needed meds for life, because drug companies and psychiatrists told GP’s that. It was a lie to sell drugs.

I am glad that my post yesterday sparked off some dialogue between you and Dr Terry Lynch, and I sincerely hope that you read his new book ‘Depression Delusion‘ (and the others) because I think that you perhaps need to read deeper into this subject. When most people seek ‘treatment’ (as you are recommending) for any kind of depression or anxiety problem, they will be offered SSRI drugs as first line treatments. There might be many roads to take in theory, but if people go to seek help they will invariably go to their GP or psych services. GP’s and psychs use drugs as the first port of call. So when you push people to get ‘treatment’ and the only treatment that’s usually available (In Ireland through the public system at least) is drugs then you are not providing them with other options. If you are doing this- then you are promoting the (psychiatric/drugs industry) medical model for treating depression (whether you realize it or not). Therefore, if you intend to continue to do this, you must adequately warn people that they will have to wait at least 6 months for psychotherapy, and that they will be encouraged to take meds before any talk therapy. You also must warn them of the dangers of these meds- not doing this is putting people in harms way (because not everyone is as informed as bloggers and ex-SSRI users like me- that’s in essence why I blog).

It’s your duty to warn.

Secondly, I would like to say, that I myself have suffered from depression and anxiety since my teens, and I have been campaigning on issues of mental health in Ireland, and elsewhere, for over 10 years. I’m not as high profile as you, but I have done a lot of work on this subject. If you read my blog you will see that I have over 8 years of posts on this blog, and I also have over 800 posts detailing much of my varied reading about this stuff.

We are close enough in age, and we would have a lot in common, however, I think that you need to do a bit more reading on Depression, the pharmaceutical industry, and psychiatry etc. In particular you should maybe read Dr David Healy’s work (he has many books and a blog), also I would recommend Dr Terry Lynch, and Dr Peter Gotzsche. There are many more authors, and many of these individuals are professors and experts in their field. The area of mental health is vastly complex, there are many voices. Biological psychiatrists like Jim Lucey offer only one approach, and that approach has been criticized hugely because it doesn’t address the core needs of the individual suffering in distress, it treats their humanity as if it was a mere faulty brain problem.

Thirdly, you should also question Dr Jim Lucey, and the general ideology which he makes his living off (academic/biological psychiatry). The information which he has provided as advice, on your website, about anti-depressants, is not only misleading but it is also inaccurate, and personally, I believe, by not revealing information on side effects etc, this misinformation can easily cause harm.

I was diagnosed with depression when I was 21, and the worst thing that I did was allow a doctor to prescribe me the SSRI Seroxat for over 3 years. If you google on the internet, you will see that Seroxat is the most notorious drug of recent times. There were 4 BBC panorama documentaries on it from 2002 to 2007. These documentaries would be a good starting point if you’re interested in learning about Seroxat. As you will see, there is a huge industry and ideology benefiting from the sale of SSRI anti-depressants like Seroxat. In Ireland Lundbeck are the major player, as they sell millions worth of Cipramil, and Lexapro. Lundbeck sponsor Aware, and are closely linked to St Pat’s and the agenda of biological psychiatrists like Jim Lucey. These conflicts of interest between Lundbeck and Aware have been documented on many blogs, forums etc over the years. Lundbeck’s only interest is selling as many SSRI’s as possible, hence why they sponsor academia, patient groups, universities, etc etc. However, Leonie Fennel’s blog is a good starting point in relation to Lundbeck’s strangle hold on Irish Psychiatry and the promotion of Depression as a disease model. Lundbeck are in this for profit, and most of Irish psychiatry cares more about protecting its interest, than the interest of patients (so beware is all I am saying). Furthermore I have no doubt that Jim Lucey believes in what he is saying, however the information he has put on your website is misleading, deceptive and highly questionable. He is basically advertising SSRI’s above and before exercise, diet, lifestyle changes etc. I find this ironic considering that you yourself claim not to take drugs to treat your depression and anxiety, and instead choose exercise to beat your demons and make yourself feel better, yet you allow Lucey to claim that drugs are better!

Also, although Jim claims that ‘rarely anti-depressant meds need to be taken longer’ (than 12 months), many people are in fact- kept on them for much longer- and many people also can’t come off them! Jim needs to warn people of this! (not warning people is negligent in my opinion). I’d also be very interested in a more thorough explanation from Jim about how these drugs ‘restore brain connectivity’, this statement is simply outrageous (I’m sure Terry Lynch would be able to explain why much better than me though).

I went to Aware meetings in my twenties, and I found that they just pushed drugs, we were told to stay on our ‘medications’. My doctor, at the time didn’t monitor me on Seroxat either, and I had horrendous side effects, again- nobody told me about them either. I was told I had a chemical imbalance, and needed them for life, however, I haven’t been on them in 13 years, and like you I deal with my depression and anxiety my own way. If you are going to promote St Pat’s, Jim Lucey, and the biological psychiatry agenda, then please be sure to give balance, as there are many mental health service users who have been harmed by psychiatry and psychiatric drugs so please be mindful of that demographic.

Also, if you intend to advertise these ‘treatments’ on your web site, you should really put a disclaimer on it explaining side effects such as increase in suicidal thoughts, aggression, withdrawal, akathsia etc. These side effects are very common, they are also very harmful, frightening and dangerous (Jim Lucey won’t advertise that though!). Medication might have a place, but the way Irish psychiatry, GP’s and the industry, have treated patients over the years has been deplorable; over prescribing has killed people (see Seroxat study 329), and has also left a lot of damage for those that were prescribed these drugs (particularly long term). If you really want to help and educate people, warn them of side effects with psychiatric drugs, and research them yourself. Mad In America is a good place to start.

And Fourthly, I would like to say, I am disappointed that you choose to block me on Twitter, it doesn’t bother me, but I do think if you intend to market yourself as a mental health advocate, and make a career out of your experiences with mental health, then perhaps dismissing other people’s experiences is not the most ethical and inclusive way to go about it? You will see that there are many more opinions and views similar to mine, there are a lot of people out there (professionals and members of the public) who shudder when they see people like Jim Lucey pushing misinformation about meds and depression. There are many who would be horrified to know that the idea of a chemical imbalance as the main cause of depression is still being perpetrated. There are many of us who have spent years campaigning for informed consent, and better mental health care and ethical treatment of the mentally ill in Ireland, and beyond.

Lastly, I wish you well in your campaigning, it takes guts to speak out, but just don’t get sucked into the agenda of St Pat’s and the ‘chemical imbalance’ psychiatrists. I’m sure they are only too delighted to have someone of your celebrity giving them this PR, don’t let them mislead you…

Anti-depressants: Psychiatry needs to wake up

On Monday I reported for the Irish Examiner on comments made by Dr Declan Gilsenan, a former deputy state pathologist, who highlighted his concerns about a link between SSRI anti-depressants and suicide. In a nutshell Dr Gilsenan said he had seen too many cases where people who had taken their own lives had recently begun taking SSRI anti-depressants.

He also referred to a high profile case in recent years in this country, on which he worked, and was concerned about due to toxicology reports he carried out. I won’t go into the details of the case again, as needless to say I have already been accused of using a family’s grief for a story and don’t want that to happen again.

What I am interested in is the bigger picture. People like Dr Terry Lynch, Dr Gilsenan and others are speaking out on an important issue, but unfortunately their voices are drowned in a sea of opposition from mainstream psychiatry.

Worryingly, the people that often get the most air time in this country are those who continue to deny that legally prescribed drugs can be harmful.

On RTE radio on Monday at the end of a debate on autism, Pat Kenny’s resident psychiatrist Prof Jim Lucey said Dr Gilsenan’s views were “a classic example of a single dimemsional divide” that occurs in the suicide debate. Not sure exactly what that means, but he went on to say there is “no evidence” that anti-depressants cause suicide, and referred to an “anti-psychiatry movement”. Prof Lucey instead preferred to blame alcohol for a rise in suicide. I was under the impression that we Irish had always drunk copious amounts, so why all of a sudden is it driving us to suicide? Perhaps the issue of alcohol mixed with legally prescribed drugs would be a more valid argument. Coroners up and down the country have been commenting on the number of cases where legally prescribed drugs are a factor in deaths.

After a RTE Frontline debate on mental health earlier this year, psychiatrist Prof Patricia Casey wrote an inflammatory piece for the Irish Independent saying the programme could “cost lives”.

Minister Kathleen Lynch had bravely spoken out saying she believed depression medication was only for short-term use

According to Prof Casey: “What was most worrying was the suggestion that if only we had enough talking therapies the problem of depression would be reduced and so too would suicide.”

Psychiatry needs to wake up. It has a dark history, and comments like this serve only to highlight how out of touch some of its disciples are.

Speaking to people like the inspirational Joan Freeman of Pieta House, and Dr Terry Lynch, they believe that’s exactly what people need – to talk. Some will need medication too of course, but therapy needs to the biggest part of their recovery. Robert Whitaker was in Ireland last year, and his book, Mad in America should be read by every psychiatrist to remind them just where their profession originated.

Prof Healy, who is Irish but based in the UK, has been involved as an expert witness in homicide and suicide trials involving psychotropic drugs, and in bringing problems with these drugs to the attention of American and British regulators, as well raising awareness of how pharmaceutical companies sell drugs by marketing diseases and co-opting academic opinion-leaders, ghost-writing their articles.

It was heartening to hear Minister Kathleen Lynch congratulating Dr Gilsenan for speaking out, and to see others coming out in support of him.

Psychiatry needs to wake up to the dangers of the drugs they are prescribing.

Professionals in this area really need to be more proactive in warning people about dangers. Yes extreme side effects only happen in a small minority of people but they still happen and can cause great harm.

Even the pharmaceutical companies who make them recognise the dangers.

What I and many others am interested in is the bigger picture, which as an editorial in the Examiner pointed out, surely can no longer be ignored.